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OBSERVATIONS ON OPIUM.

By Carroll Dunham, M. D., New York.

No drug is so universally used in the old school of medicine. The great Hufeland affirmed that if he had to choose one remedy from the Materia Medica for exclusive use it should be Opium. Its extensive use among Allopathists follows from these facts. The old school have been few specifics, and these are but seldom used. Most diseases being attended with pain, the pain must be either subdued by acting specifically upon the causes of pain, or else the pain must be relieved by a palliative anodyne, while the disease is sought to be cured by the use of revulsive agents addressed to other organs of the body than those which are the seat of disease. The latter is the mode almost universally employed. Hence the constant use of anodynes. For example, in severe sclerotitis, the old school would use revulsive agents addressed to the bowels (purges) and to the skin (blisters). But at the same time, to subdue the pain in the eye, a dose of Opium would be given.

Now Homoeopathy does not do so. It gives a drug that acts specifically on the cause of disease and upon the organ diseased and no other, and there is no need of an anodyne. These are the reasons why Opium is so much used by Allopaths and so little by Homoeopathicians.

Hahnemann's observations, though requiring some modification perhaps in consequence of the wider experience of later years, are most instructive. “The primary result of weak and moderate doses, during whose action the organism is affected in a passive manner, appears to be that of exciting for a short time the irritability and activity of the muscles subject to its action, but also to diminish for a longer time that of the muscles which are not subjected to its influence; to excite the imagination and the courage, but also to deaden and stupefy the feelings, the sensibility and the presence of mind. Under a longer continuance of its action, the organism, by its power of reaction, produces a condition exactly the reverse, a want of excitability and activity in the involuntary muscles, an absence of ideas, languor of imagination with timidity and oversensibility of the general feeling. Certain symptoms are more palpable in some individuals than in others. No medicine relieves suffering sooner than Opium. It is this property that has induced physicians to employ it so largely - a source of innumerable evils. If the use of Opium in disease were as beneficial as it is frequent, no other medicine would make so many cures; but exactly the reverse takes place.

“The power of this medicine and its rapid action indicate that its effects should be thoroughly studied before using it.

“Now, as Opium has hitherto been but little used, excepting as an antipathic and a palliative and its primary effects only have been opposed to diseases, no medicine has appeared so soothing or has so apparently suppressed morbid symptoms, although soon followed by results more distressing than the original disease. In short, nothing has caused more positive evil after apparent good.

“In all kinds of coughs, diarrheas, vomiting, sleeplessness, melancholy, spasms, nervous affections, and, above all, in severe pain, Opium is indiscrimately given, on the ground that it is the best remedy in such cases. But its innumerable evil results do not appear among the primitive effects of Opium which are precisely the reverse.

“Therefore we may easily imagine how few salutary and enduring effects can be obtained in the greater number of morbid and physical affections; and this is proved by daily experience.

“If Opium has been found to cure cough, diarrhea, sickness, spasms, etc., etc., in a few cases, it is only when these symptoms first show themselves in persons previously in good health and are but slight. Opium will sometimes restore the patient quickly to health, because, if these symptoms are at once destroyed, the body is restored to its former condition and the tendency to their return is suppressed.

“But, because this palliative action on slight and recent cases succeeds in a few instances, it does not follow that Opium really possesses the power of curing them permanently in all cases.

“It cannot convert them into sound health because they are symptoms of other diseases with which Opium does not conicide homoeopathically. For this reason, it has seldom been used without injury to the patient, in long standing coughs, continued diarrheas, habitual wakefulness, chronic sickness, spasms, anxiety and tremors, when they have been for some time established.

“In administering Opium for these complaints, we see that it is on the principle of soothing, procuring a temporary suspension of suffering; that subsequently it will relieve only by increasing the dose, which even then becomes less effective and at the same time creates new diseases, an artificial malady, still more serious and distressing than the first.

“But it is yet more striking to observe that up to the present time, the use of Opium has been abused by giving it in all kinds of pains, however deep seated and of however long standing. It shocks our understanding and seems like returning to the absurd idea of a universal medicine, to expect from it the cure of diseases totally different to each other.

“All pains soothed, for the moment, by Opium, return after a short time, when the stupefying effect is past, and very often are still more intense than before; so that at last they will only yield to stronger and larger doses which create in return other serious diseases new to the sufferer. The use of Opium in confirmed pain is therefore empirical and deceptive to the patient, leading him to attribute to other diseases the mischievous consequences that are due to it alone.

“By treating all pains antipathically by Opium, we have seen the use of this drug bring on a train of evil consequences - stupor, constipation and other serious symptoms which appertain to Opium, and without which it would not be what it is. But persons have deceived themselves as to the character of these inevitable effects. Instead of perceiving in them results inherent in the nature of Opium, they have considered them as derived from some accessory properties which they have taken unwearied pains to separate from it. Hence the various correctives that have been tried for two thousand years, in the hope of soothing spasms and pains, without bringing on delirium or constipation; of suppressing vomiting or diarrhea without causing stupor; of procuring sleep without heat, headache, tremors, languor, depression and extreme sensitiveness to cold.

“But all this is fallacious. By all these means Opium is only rendered less active, without changing its nature.”

By a series of arguments and illustrations of this character, Hahnemann shows that the almost universal use of Opium is a resort to a temporary palliative of suffering, not to a specific for the cause of that suffering whatever that cause may be. Whereas Opium could only be used with propriety in those diseases to which the correspondence of its symptoms shows that it may be a specific remedy. These are very few in number. Hence Homoeopathists make infrequent use of Opium.

Instead of an elaborate analysis of the Opium symptoms, I shall call attention only to a few of the infrequent application of Opium, viz. :

In apoplexy; constipation; lead colic; wakefulness.

Apoplexy.- The following description of the effect of a large dose of Opium is taken from Stille and Beck:

“The head feels full and hot and sometimes light, there are buzzing noises in the ears, the face and eyes are injected, while the pupil is more or less contracted. Flashes of light are apt to appeal before the eyes; the ideas are confused and extravagant, and sometimes there is delirium; the pulse is fuller and more frequent; the skin is hot, the month and fauces dry; generally there is nausea and, in some cases, vomiting. To those symptoms depression succeeds. The pulse beats more slowly and often irregularly; the head feels heavy and full, and all the senses lose their acuteness; the countenance assumes a stolid, stupid, besotted expression, produced by the turgidness of the features, the dullness of the eyes and the drooping of their lids; there is a strong indisposition to think or move; or, more properly, an inability to make any exertion, either of mind or body; the speech is thick and hesitating; the muscles of the limbs are affected with spasmodic movements and, if the patient attempt to walk, he feels dizzy and oppressed, and staggers like a drunken man.

“An irresistible propensity to sleep follows these symptoms and when yielded to, the breathing becomes laborious and often stertorous, while the general surface of the body grows pale and damp, and the hands and feet cold.” The effects of still larger doses are similar, though more decided and not preceded by a period of excitement. They are “giddiness insensibility and immobility, respiration hardly perceptible, and a small feeble pulse, which sometimes becomes full and slow. The eyes are shut, the pupils contracted, and the whole expression of the countenance is usually that of deep and perfect repose. As the effects increase, the lethargic state becomes more profound, deglutition is suspended, the breathing is occasionally stertorous, the pupils are insensible to light, the countenance is pale and cadaverous, and the muscles of the limbs and trunk are relaxed,”

These same words might be used to describe one form of cerebral apoplexy.

“After death from Opium-poisoning, the convolutions of the brain are found to be flattened, the vessels of the cerebrospinal axis and its investing membranes are gorged with black blood, and the capillaries of the brain give out on incision minute drops of the same fluid. A serous liquid is usually met with in the ventricles of the brain and under the cerebral face of the arachnoid membrane.”

Thus both the symptoms and the post-mortem appearances resemble those of one form of apoplexy, and it is not therefore surprising that Opium has been found a most valuable remedy in even apparently hopeless cases of this affection.

It would seem that we should hope more from it when the apoplexy had not been preceded by chronic symptoms of lesion in the substance of the eucephalon, such as would indicate a destructive process (softening, for example,) as going on for some time prior to the apoplectic stroke. In such cases we have undoubtedly a considerable coagulum in the brain-substance and the case would naturally be almost hopeless.

In several severe cases of cerebral apoplexy, with very profound coma, where Opium had entirely failed, Dr. J. Barker, of Brooklyn, has succeeded in affecting a cure with Apis. In his opinion, which is based on much experience with this remedy, Apis is a medicine of great importance in cerebral and spinal affections, whether they manifest themselves chiefly by coma or by spasms.

Constipation. - Opium produces a suspension of the secretion from the mucous surfaces of the digestive canal, e. g., the dry mouth and fauces. It probably, therefore, lessens the amount of excrement. It also paralyses the intestine. These two actions combine to produce an obstinate constipation, an effect of Opium which is universally admitted, recognized and, by Allopaths, regretted. We are, however, enabled by it to cure certain analogous forms of severe constipation.

Most prominent among these is the constipation from paralysis of the intestine caused by Lead, and known as a concomitant of “painter's colic.”

Retention of Urine. - It is doubtful whether Opium diminishes the secretion of urine, but it certainly does cause its retention in the bladder. This it does, perhaps, chiefly by blunting the sensibility of the lining membrane of the neck of the bladder, so that the fullness of the bladder is not recognized by the patient. It may also paralyse the longitudinal and circular muscular fibres of the bladder. Though the mass of the urine is retained and the bladder full, yet some urine may dribble away, unknown to the patient.

This whole condition is very different from that produced by Stramonium, which produces suppression of urine, causing the kidneys to suspend their function.

In retention of urine, Opium is our best remedy. It may occur in fever, in acute illnesses or, frequently, after childbirth.

Do we never use Opium as a palliative in acute and very painful affections for which we have not found a specific remedy? I have twice thought it necessary to do so. On each occasion I regretted it. It did mischief. The patients, after a temporary relief, got worse and then, after all, I found, by hard study, the proper remedy (as I ought to have done at first) and cured the cases, as I might and ought to have done in the beginning, without Opium, had I known enough.

In evidently uncurable diseases when the patient is moribund, as in cancer, etc., Opium may perhaps be given, but even in such cases, though there be no hope of recovery, it should be sparingly used.